The Future of the Affordable Care Act

What can we expect from 2015?

It’s a new year, which means a new chapter in the life of the Affordable Care Act. With the Republican party in control of the senate and the Supreme Court weighing in on subsidies at the federal level, it appears as if there is a lot of uncertainty ahead in the world of Health Care. Fortunately, the potential outcomes for the Affordable Care Act are easy to, at least, speculate about, and through education we can all prepare for what 2015 might hold.

Option #1: Repeal

One scenario is that the Republicans will repeal the Affordable Care Act. You are probably familiar with this idea because it sat at the centerpiece of many re-election campaigns. Although the passion to act on this promise is palpable, the likelihood of it happening seems slim. The Republicans need 60 votes in the Senate in order to defeat a filibuster that would keep the vote from coming to the floor. Even if the party could strongly unite towards the goal of repealing the ACA, the President will be likely to veto any bill that sets out to accomplish and a ⅔ vote in the House & Senate to override the President’s veto is probably not on the agenda for the 2015 political calendar.

Option #2: Reform

The American people seem to mostly agree on at least one thing, the Affordable Care Act isn’t all bad. From coverage up to age 26 to elimination of pre-existing conditions, some of the key provisions of The ACA have had a positive impact on the lives of both individuals and families. If the ACA was repealed, some of these more popular policies would also fall by the way-side, disappointing the voters that selected the members of the 2015 congress.

The problem is, in order to improve some of the perceived weaknesses of the Affordable Care Act, our government would have to work together towards a unified outcome. This means Republicans and Democrats in both the Senate and the House, and President Obama have to embrace a bipartisan effort to improve upon what we’ve already got. It may seem hard to believe, but examples of this sort of teamwork (specifically regarding The ACA) do already exist and could (maybe?) become even more frequent in the year to come.

Option #3 Replace

Similar to reform, there is the potential of replacing the existing ACA policies with a new and improved version. Leading Republicans, like Orrin Hatch, are particularly keen on repealing and replacing the Affordable Care Act.

The downside is this puts us back at square one. The effort of repealing and replacing will likely take many years rather than coming to fruition this year.

Option #4: Supreme Court Pushing Compromise?

The Supreme Court has decided to hear the King v. Burwell appeal. As of right now, the Affordable Care Act only provides subsidies for insurance purchased in state Exchanges. So what about the more than 35 states that have federal Exchanges? That’s exactly what the Supreme Court aim to determine: Are individuals purchasing insurance on federal Exchanges eligible for subsidies and tax-credits?

Let’s say the Supreme Court decides that subsidies aren’t available in federal exchange states. This could mean the death of the ACA because millions of people will not be able to afford coverage. Additionally, “pay-or-play” penalties would no longer be implementable because they are only assessed when employees gain subsidized coverage.

The moral? Maybe the government will work towards a compromise rather than let the Supreme Court decide. This puts us back to Options #1 & #2, but under a tighter time frame encouraged by amicable political behavior.

So what’ll it be?

That’s a great question, with no concrete answer. There are a lot of factors influencing the fate of the Affordable Care Act. If we’re expecting to experience some finality in 2015, it’ll only happen when bipartisan compromise becomes the name of the game. King v. Burwell sets the tone for this sort of behavior and an appreciation of some of the positives of the ACA will lead the charge. The rest remains to be seen.

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